MEDICARE: SAVVY DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27076	OTHER	TX	TEXAS BOARD OF DENTAL EXAMINERS

General Provider Information

NPI Number	:	1265904171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAVVY DENTAL PLLC

Provider Business Mailing Address
First Line	:	1005 N MECHANIC ST
Second Line	:
City	:	EL CAMPO
State	:	TX
Zip	:	77437-3027
Country	:	US
Telephone Number	:	979-543-2411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 N MECHANIC ST
Second Line	:
City	:	EL CAMPO
State	:	TX
Zip	:	77437-3027
Country	:	US
Telephone Number	:	979-543-2411
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAUN WILLIS
Credential	:	DMD
Telephone Number	:	979-543-2411

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	12/18/2018

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Directions to “SAVVY DENTAL PLLC ” Practice Location

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